Required Field

 

Section 1 - Personal

 

Who is going to make the application (policyowner)?

 

Applicant

* *

*

* *

Section 2 - Whose life is to be insured?

Ist life assured

* *

* Occupation * Income (£)

Do you smoke?

We need to know your income because life offcies impose restrictions on how much life cover you can have in relation to your income.

2nd life assured (joint lives)

Occupation Income (£)

Do you smoke?

We need to know your income because life offcies impose restrictions on how much life cover you can have in relation to your income.

Section 3 - Existing protection

Do you have any existing life assurance?

Section 4 - Protection needs

Mortgage

Do you want to protect your mortgage?

If Yes, what type? Do you have any existing life assurance?

If Yes, how much? (£) Remaining policy term - years

Other loans

f Yes, the amount outstanding (£)

Income

(maximum 10 x income)

How long would you like the income to be paid? If Yes by how much?

Do you have any existing life assurance to cover income?

If Yes, how much? (£) Remaining policy term years

To insure your life on death? and or to insure on diagnosis of a critical illness?

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